Recommended Immunization Schedule
Follow the CDC/ACIP-approved immunization schedules that provide age-based and risk-based vaccination recommendations for both children (0-18 years) and adults (≥19 years), with annual influenza vaccination universally recommended for all persons ≥6 months of age. 1, 2, 3
Children and Adolescents (0-18 Years)
Routine Childhood Vaccinations
Birth through 18 months:
- Hepatitis B (HepB): 3-dose series starting at birth, with subsequent doses at 1-2 months and 6-18 months 1
- Rotavirus: 2- or 3-dose series depending on vaccine formulation, starting at 2 months 4
- DTaP (Diphtheria, Tetanus, Pertussis): 5-dose series at 2,4,6,15-18 months, and 4-6 years 1
- Haemophilus influenzae type b (Hib): 3- or 4-dose series at 2,4,6 (if needed), and 12-15 months 1, 5
- Pneumococcal conjugate (PCV13): 4-dose series at 2,4,6, and 12-15 months 5
- Inactivated Poliovirus (IPV): 4-dose series at 2,4,6-18 months, and 4-6 years 1
12 months through adolescence:
- MMR (Measles, Mumps, Rubella): 2-dose series at 12-15 months and 4-6 years; if not previously vaccinated, administer 2 doses ≥4 weeks apart 1
- Varicella: 2 doses at 12-15 months and 4-6 years; for those <13 years, doses should be ≥3 months apart 1
- Hepatitis A: 2-dose series starting at 12 months, with doses ≥6 months apart 1, 5
Adolescent Vaccinations (11-18 Years)
- Tdap (Tetanus, Diphtheria, Pertussis): Single dose at age 11-12 years for those who completed childhood DTP/DTaP series; catch-up dose for ages 13-18 if missed 1
- HPV (Human Papillomavirus): 2- or 3-dose series starting at age 11-12 years for both males and females; 2-dose series if initiated before age 15 (doses 6-12 months apart), 3-dose series if initiated at age ≥15 years (0,1-2,6 months) 1, 2
- Meningococcal conjugate (MCV4): Dose at age 11-12 years with booster at age 16 years 1
- Annual influenza vaccine: Starting at 6 months of age and continuing annually 1, 3
Important caveat: Children <9 years receiving influenza vaccine for the first time require 2 doses separated by ≥4 weeks. 1
Adults (≥19 Years)
Universal Adult Vaccinations
- Influenza: Annual vaccination for all adults ≥6 months without contraindications; adults ≥65 years should preferentially receive high-dose inactivated, recombinant, or adjuvanted formulations 2, 3
- Td/Tdap: Td booster every 10 years; substitute one Td dose with Tdap if not previously received in adulthood 1, 2
- COVID-19: All eligible patients should receive SARS-CoV-2 vaccines per current guidelines 6
Age-Based Adult Vaccinations
Ages 19-49 years:
- HPV: 3-dose series for females through age 26 and males through age 21 (can extend through age 26 for MSM and immunocompromised) 1, 2
- MMR: 1-2 doses for those born in 1957 or later without evidence of immunity 1
- Varicella: 2-dose series (4-8 weeks apart) for those without evidence of immunity 1
Ages 50-64 years:
- Zoster (Shingles): Recombinant zoster vaccine (RZV/Shingrix) preferred: 2-dose series for all adults ≥50 years 1, 2, 7
Ages ≥65 years:
- Pneumococcal: PCV13 based on shared clinical decision-making, followed by PPSV23 at least 1 year later (or PPSV23 alone if PCV13 not given); newer 15- or 20-valent pneumococcal conjugate vaccines are now recommended 1, 2, 6
- Zoster: RZV 2-dose series if not previously vaccinated 2, 7
Risk-Based Adult Vaccinations
Immunocompromising conditions (HIV, transplant, immunosuppressive therapy):
- Pneumococcal: PCV13 followed by PPSV23 at least 8 weeks later; revaccination with PPSV23 every 5 years 1, 2
- Meningococcal ACWY: 2-dose series at least 8 weeks apart, revaccinate every 5 years if risk persists 1
- Meningococcal B: 2-dose series (MenB-4C) or 3-dose series (MenB-FHbp) 1
- Hib: 1 dose for asplenia; 3-dose series for HSCT recipients starting 6-12 months post-transplant 1
- Avoid live vaccines (LAIV, MMR, varicella, live zoster) in severely immunocompromised patients 1, 7
Chronic medical conditions (diabetes, heart/lung/liver disease, alcoholism):
- Pneumococcal: PPSV23 for ages 19-64 years with chronic conditions; PCV13 followed by PPSV23 at age ≥65 1, 2
- Hepatitis B: 2- or 3-dose series for chronic liver disease, end-stage renal disease, diabetes 1, 2
- Hepatitis A: 2-dose series for chronic liver disease 1, 2
Occupational/behavioral risk factors:
- Hepatitis B: Healthcare workers, public safety workers exposed to blood, sexually active persons not in monogamous relationships, injection drug users, MSM 1, 2
- Hepatitis A: Laboratory workers with hepatitis A virus, MSM, persons who use drugs, travelers to endemic areas 1, 2
- Meningococcal ACWY: Microbiologists exposed to Neisseria meningitidis, travelers to hyperendemic areas 1, 2
Pregnancy:
- Tdap: During each pregnancy, preferably between 27-36 weeks gestation 2
- Influenza: Inactivated vaccine during any trimester 2, 3
- Contraindicated: MMR, varicella, live zoster, LAIV; delay HPV until after pregnancy 1
Common Pitfalls and Key Considerations
Catch-up immunization: Adults with uncertain vaccination history should receive a complete primary series rather than assuming prior vaccination. 1, 4
Vaccine interchangeability: Complete series with same product when possible, particularly for meningococcal B vaccines (MenB-4C and MenB-FHbp are not interchangeable). 1
Timing between vaccines: PCV13 and PPSV23 should not be given during same visit; maintain at least 8 weeks between doses for high-risk patients or 1 year for routine vaccination at age ≥65. 1, 2
Live vaccine precautions: Space live vaccines by ≥4 weeks if not administered simultaneously; avoid in pregnancy and severe immunocompromise. 1, 7
Egg allergy: Adults with egg allergy (even severe) can receive any age-appropriate influenza vaccine in a medical setting. 1, 3